The endoscopy safety checklist:A longitudinal study of factors affecting compliance in a tertiary referral centre within the United Kingdom

Gastrointestinal endoscopy is a widely used diagnostic and therapeutic procedure both within the United Kingdom and worldwide. With an increasingly older population the potential for complications is increased. The Wolfson Unit for Endoscopy at St. Mark's Hospital in London is a tertiary referral centre, which conducts over 14,000 endoscopic procedures annually. However, despite this high throughput, our baseline observations were that the procedure for safety checks was highly variable. Over a seven-day period we conducted a questionnaire-based survey to all staff members involved with endoscopy within our unit. We found that there was little consensus between team members, both in terms of essential safety checks and designating responsibility for the checks. A panel of experts was convened in order to devise a safety checklist and a strategy for increasing compliance with the checklist among all staff members. Using a combination of electronic and physical reminders and incentives, we found that there was a significant increase in completed checklist (53% to 66%, p = 0.021) and decrease in the number of checklists left blank post intervention (10% to 2%, p=0.03). We believe that post implementation validation of safety checklists is an important method to ensure their proper use.</p

Creation of an institutional preoperative checklist to support clinical risk assessment in patients with ulcerative colitis (UC) considering ileoanal pouch surgery

Background: Total proctocolectomy with ileal pouch–anal anastomosis (IPAA) is the most established restorative operative approach for patients with ulcerative colitis. It has associated morbidity and the potential for major repercussions on quality of life. As such, patient selection is crucial to its success. The main aim of this paper is to present an institutional preoperative checklist to support clinical risk assessment and patient selection in those considering IPAA. Methods: A literature review was performed to identify the risk factors associated with surgical complications, decreased functional outcomes/quality of life, and pouch failure after IPAA. Based on this, a preliminary checklist was devised and modified through an iterative process. This was then evaluated by a consensus group comprising the pouch multidisciplinary team (MDT) core members. Results: The final preoperative checklist includes assessment for risk factors such as gender, advanced age, obesity, comorbidities, sphincteric impairment, Crohn’s disease and pelvic radiation therapy. In addition, essential steps in the decision-making process, such as pouch nurse counselling and discussion regarding surgical alternatives, are also included. The last step of the checklist is discussion at a dedicated pouch-MDT. Discussion: A preoperative checklist may support clinicians with the selection of patients that are suitable for pouch surgery. It also serves as a useful tool to inform the discussion of cases at the MDT meeting

Improving safety and quality in endoscopy patient pathways

Patient safety is a key priority as it is acknowledged that medical error is common, multifactorial and often avoidable. Gastrointestinal endoscopy is increasingly a therapeutic procedure not without risk. Current training in endoscopy focuses on technical aspects with no formal recognition of non-technical skills such as communication, leadership, decision-making and teamwork. Error analysis in other medical specialties suggests that non-technical skills are often implicated. Recognition, understanding and training in endoscopic non-technical skills may enhance team-working skills and contribute towards patient safety. The overarching aim of this thesis is to understand the breadth of errors that occur in endoscopy and to objectively evaluate non-technical skills and teamwork in endoscopy and the colorectal cancer multi-disciplinary team. Based on this, measures to mitigate error enhance teamwork and non-technical skills will be implemented and evaluated. Part A of this thesis focuses on identifying and defining problems impacting patient safety in endoscopy. The introductory chapter details the emergence of patient safety and quality within healthcare and contextualises the importance of these concepts for endoscopy. In Chapter 2 endoscopy team members’ attitudes towards patient safety in endoscopy are explored coupled with a prospective evaluation of the frequency, type and severity of patient safety incidents. Teamwork processes are examined and presented in Chapters 3 and 4 by scientifically evaluating safety checks, technical and non-technical skill by endoscopy teams conducting elective and emergency procedures respectively. Chapter 5 evaluates the extended endoscopy pathway by measuring performance in the colorectal cancer MDT by assessing teamwork, decision-making and errors across key patient groups. Educational strategies and quality improvement interventions are implemented to support patient safety beyond endoscopy. In part B of this thesis specific interventions to enhance the safety and quality issues identified in part A are presented. Chapter 6 aims to determine the feasibility and effectiveness of a novel multi-disciplinary team training intervention for bowel cancer screening teams by targeting non-technical skills, error analysis and enhanced team performance strategies. Finally in Chapter 7 an endoscopy safety checklist is proposed and implemented into clinical practice. The checklist was prospectively evaluated in detail to examine effects on safety checks, patient safety incidents, technical and non-technical skills. In summary, this thesis serves to identify clinically transferable approaches to improve patient safety within endoscopy.Open Acces

Diagnostic ileocolonoscopy: getting the basics right

Proficient colonoscopy technique that optimises patient comfort while simultaneously enhancing the timely detection of pathology and subsequent therapy is an aspirational and achievable goal for every endoscopist. This article aims to provide strategies to improve colonoscopy quality for both endoscopists and patients.</jats:p

Endoscopic non-technical skills team training:The next step in quality assurance of endoscopy training

AIM: To investigate whether novel, non-technical skills training for Bowel Cancer Screening (BCS) endoscopy teams enhanced patient safety knowledge and attitudes.METHODS: A novel endoscopy team training intervention for BCS teams was developed and evaluated as a pre-post intervention study. Four multi-disciplinary BCS teams constituting BCS endoscopist(s), specialist screening practitioners, endoscopy nurses and administrative staff (A) from English BCS training centres participated. No patients were involved in this study. Expert multidisciplinary faculty delivered a single day's training utilising real clinical examples. Pre and post-course evaluation comprised participants' patient safety awareness, attitudes, and knowledge. Global course evaluations were also collected.RESULTS: Twenty-three participants attended and their patient safety knowledge improved significantly from 43%-55% (P = 0.001) following the training intervention. 12/41 (29%) of the safety attitudes items significantly improved in the areas of perceived patient safety knowledge and awareness. The remaining safety attitude items: perceived influence on patient safety, attitudes towards error management, error management actions and personal views following an error were unchanged following training. Both qualitative and quantitative global course evaluations were positive: 21/23 (91%) participants strongly agreed/agreed that they were satisfied with the course. Qualitative evaluation included mandating such training for endoscopy teams outside BCS and incorporating team training within wider endoscopy training. Limitations of the study include no measure of increased patient safety in clinical practice following training.CONCLUSION: A novel comprehensive training package addressing patient safety, non-technical skills and adverse event analysis was successful in improving multi-disciplinary teams' knowledge and safety attitudes.</p